This proposal seeks five years of support for Douglas K. Richardson, M.D., M.B.A. on a Midcareer Investigator Award in Patient-Oriented Research. The program offers a unique combination of a mid-career clinical investigator who has a demonstrated passion for mentoring, a well-established research training program, and the intellectually rich environment at Harvard School of Medicine. Dr. Richardson is a clinical neonatologist, and an established, internationally recognized researcher. The applicant's area of expertise, perinatal health services research, is both central to the national goals for improving the health of women and children, and is seriously under-supplied with well-trained clinical investigators. Dr. Richardson's primary focus has been documenting the marked variations in mortality, morbidity and resource use among neonatal intensive care units (NICUs). Dr Richardson and his colleagues developed and validated the now standard measure of illness severity in NICUs. More recently, the applicant has been expanding his studies to multi-hospital networks, as well as analyzing the policy implications of de-regionalization of perinatal care. In the process, the applicant has mentored 32 individuals in first-authored articles and/or abstracts, including clinical fellows, instructors and assistant professors, nurse researchers, and medical and/or graduate students. In addition, this investigator and his colleagues have an excellent track record in recruiting and training under-represented minorities. Specific aims are for research and mentoring respectively: 1) to develop benchmarks and measurement tools for quality improvement interventions in NICUs; and 2) to build the research infrastructure, by creating a research laboratory to benefit fellows and junior faculty researchers. The research plan entails: 1) a major effort funded by the Agency for Health Care Research and Quality (AHRQ)to define more flexible outcome markers for intermediate care (Level II) NICUs, including intermediary outcomes (growth, complications, illness states, hospital readmissions), care process (completed immunizations and neurosensory screens) and parental satisfaction; and 2) pilot studies in two multi-hospital networks to extend these findings into real-life health care settings. The mentoring plan entails: a) providing trainees a stable, high-level analytic capacity; b) ensuring computing and network access; c) acquiring a library of data sources; d) developing new programs for other types of trainees; and e) providing longer-term career support through research "tune-ups." Dr. Richardson will continue his active and productive mentoring of junior researchers.